ESA-SRB-AOTA 2019

Harnessing electronic health record data to optimise screening and management of diabetes mellitus in patients with acute myocardial infarction (AMI)   (#562)

Linda Wu 1 , Charmaine S Tam 2 3 , Richard W Morris 2 3 , Aldo Saavedra 3 , Jonathan Morris 2 4 5 , Gregory Fulcher 2 6
  1. Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
  2. Northern Clinical School, University of Sydney, Sydney, NSW, Australia
  3. Centre for Translational Data Science, University of Sydney, Sydney, NSW, Australia
  4. Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, St Leonards, NSW, Australia
  5. Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
  6. Department of Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia

 

Introduction

Studies have demonstrated that patients with diabetes mellitus (DM) presenting with acute myocardial infarction (AMI) have higher risk of mortality, cardiac failure and readmission in comparison to non-diabetic patients1,2. ’Big data’ from electronic health records (eMR) has been used extensively in overseas registries but data in the Australian setting is limited. 

Aim

To characterise the current screening, management and outcomes of patients with DM presenting with chest pain in a local health district (LHD) using data extracted from eMR.

Methods

Patients presenting with chest pain to emergency departments within the LHD from April to June 2017 were included in preliminary analysis. AMI was defined as ICD10 code STEMI/NSTEMI (I21.0-4). DM was defined as HbA1c>6.5% or DM medication on discharge or the presence of “diabetes” and related terms in any clinical documentation.

Results

From 25,984 presentations of with chest pain, 365 patients had AMI (226 males; mean age= 75y). Prevalence of diabetes was 26% (101/365). 67% (68/101) had pre-existing diabetes, of which 49% (33/68) had a HbA1c test performed and 39% (13/33) had a HbA1c>8%. Of patients without known diabetes (n=297), 23% (68/297) had HbA1c performed and 12% (8/68) had HbA1c>6.5%. 2/8 were discharged with medications for treatment of diabetes. Length of stay (LOS) was longer in those with DM (mean LOS 9.0 days) in comparison to those without (mean LOS 7.1 days).

Conclusion

Data extraction via eMR can clarify areas of practice in which management could be optimised. Screening for diabetes is practice changing yet screening rates are low even in this high risk cohort. Endpoints such as mortality and readmission are being evaluated, together with the impact of Endocrine involvement on risk-factor modification. These data will define a high risk cohort for intensive management strategies.

  1. Deedwania PC, Ahmed MI, Feller MA, et al. Impact of diabetes mellitus on outcomes in patients with acute myocardial infarction and systolic heart failure. Eur J Heart Fail. 2011;13(5):551-559.
  2. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339(4):229-234.